Wisconsin HSA Plans
There are 3 HSA eligible plans in Wisconsin, available state-wide through Blue Cross Blue Shield.
Health Savings Accounts can reduce your out of pocket costs as well as your tax burden. Learn more at our HSA Guide.
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Advantage Bronze HMO 006, Advantage Bronze 104, Advantage Silver 103
| Plan Name | Blue Advantage Bronze HMO 006 | Blue Advantage Plus Bronze 104 | Blue Advantage Silver HMO 103 |
|---|---|---|---|
| Plan Brochure | Plan Details | Plan Details | Plan Details |
| Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. | $6,500 | $5,000 | $3,750 |
| CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | None (Member pays 0% after deductible) | 40% | 0% |
| Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (includes deductible) | $6,500 | $6,550 | $3,750 |
| Primary Care Office Visit | 0% after deductible | 40% | $30 |
| Specialist Office Visit | 0% after deductible | 40% | $0 after deductible |
| Mental Illness Treatment and Substance Abuse Rehab Office Visit | 0% after deductible | 40% | 40% |
| Emergency Room | 0% after deductible | 40% | 40% |
| Urgent Care | 0% after deductible | $20 | $0 after deductible |
| Inpatient Hospital Service | 0% after deductible | 40% | $0 after deductible |
| Outpatient Surgery | 0% after deductible | 50% | $0 after deductible |
| Outpatient X-Rays and Diagnostic Imaging | 0% after deductible | 50% | $100 |
| Outpatient Imaging (CT/PET Scans/MRIs) | 0% after deductible | 50% | $0 after deductible |
| Network | Blue Advantage HMO | ||
| HSA Eligible | Yes | Yes | Yes |
| Outpatient Prescription Drugs – Preferred Pharmacy | 0% after deductible | 30%/30%/40%/50%/50% | $0 after deductible |
| Outpatient Prescription Drugs – Non-Preferred Pharmacy | 0% after deductible | 35%/35%/50%/50%/50% | $0 after deductible |
| Prescription Drug Utilization Benefit Management Programs | Specialty Pharmacy Program: To be eligible for maximum benefits, specialty medications must be obtained through the preferred Specialty Pharmacy provider. Member Pay the Difference: When choosing a brand name drug over an available generic equivalent, you pay your usual share plus the difference in cost. Prior Authorization/Step Therapy Requirements: Before receiving coverage for some medications, your doctor will need to receive authorization from BCBSWI and you may first need to try more clinically appropriate or cost-effective drugs. Mail-Order Program: You may receive up to a 90-day supply for prescription drugs through the mail-order program or at select retail pharmacies depending on your prescription drug benefit. | ||